Abstract| Volume 54, ISSUE 7, SUPPLEMENT , S26, July 2022

P018 The Pathophysiology of Food Insecurity: A Narrative Review and System Map

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      The chronic disease impacts of food insecurity have been studied extensively. There is a more contemporary appreciation, though, for how food insecurity may influence a wider array of health outcomes, and a need to synthesize the rapidly-expanding literature on relationships between food insecurity and biological antecedents of poor physical and mental health.


      To synthesize recent evidence of the complex and interdependent biological mechanisms that intermediate well-known relationships between food insecurity and health diagnoses.

      Study Design, Settings, Participants

      Narrative review of English-language, peer-reviewed, published articles was conducted based on an iterative series of searches in the PubMed electronic database and subsequent vetting of reference lists for additional studies of relevance. Studies were eligible if they analyzed relationships between measured food insecurity and one or more health-related biomarkers. Studies were not excluded due to publication year, study setting, or population to afford a comprehensive review.

      Measurable Outcome/Analysis

      Key findings were extracted and synthesized narratively. Using a framework not unlike those used to describe disease processes, the review culminated in the creation of a concept map of body systems affected by food insecurity and involved in the development of related chronic diseases.


      Research related to various isolated biological and clinical impacts of food insecurity were widely available; however, no articles characterized the impact using a systemic, pathophysiological framework. The available evidence supports the theory that food insecurity can contribute to toxic stress and a systemic inflammatory stress response. This response contributes to: poorer mental health outcomes, including heightened risk for eating disorders and depression; changes to the gut microbiome with implications for nutrient metabolism and chronic disease; and susceptibility to weight gain and central adiposity in particular, with implications for insulin resistance and metabolic syndrome.


      Food insecurity is a social risk with individual and intergenerational biological consequences. Synthesizing the most recent evidence on such consequences affords a more precise appreciation for the value of community-clinical partnerships to monitor and address it.